Health

Part 9 - Anesthesia

The Mesopotamians recorded the use of alcohol as a pain killer and were probably growing the opium poppy for the same reason before 3400 BCE, while Egyptians records suggest that an extract from the mandrake fruit was used as an analgesics. 

The legendary Chinese surgeon, Bian Que (Pien Ch'iao,  300 BCE), is recorded as using a general anesthetic during surgery.

Several of the Solanum species, which contain potent tropane alkaloids, were used for anesthesia throughout Europe, Asia, and the Americas in to mediaeval times. The Greek physician, Dioscorides, recommended henbane it as a sedative and analgesic and the hallucinogenic and narcotic mandrake root was used as an anesthetic during surgery.

Henbane was historically combined with mandrake, deadly nightshade and datura as an anaesthetic potion, as well as for its psychoactive properties in "magic brews". In 13th-century Italy, Theodoric Borgognoni used similar mixtures along with opiates to induce unconsciousness and this was used until the 19th century.

Islamic physicians introduced the use of preoperative anesthetic compounds around the 9th century.  And, in the 10th century, Islamic physicians, such as Abulcasis, Avicenna and Ibn Zuhr, used a sponge soaked with narcotic drugs, placed it on a patient's face as the first inhaled anesthetic

The "sleep sponge" was introduced to Europe by the Salerno school of medicine in the late 12th century and by Ugo Borgognoni in the 13th century.  This was a sponge soaked in a solution of opium, mandragora, hemlock juice, and other substances. This was then dried until, just before surgery, the sponge was moistened and held under the patient's nose until the patient lost consciousness.

Inca priests chewed coca leaves and spat the anesthetic into wounds as they worked. Cocaine, later isolated as first effective local anesthetic, was used in 1859 by Karl Koller during eye surgery. In 1898, German surgeon August Bier was one of the first to use cocaine for spinal anesthesia. In Britain, in 1772, scientist Joseph Priestley discovered nitrous oxide (laughing gas). Initially, people thought this gas was lethal, even in small doses, but in 1799, Sir Humphry Davy noted its potential anesthetic properties to relieving pain during surgery. However, it was mainly used for recreation until about 1844 when it was adopted by dentists and for surgery.

Ether, may have been known in the 8th century and, in the 16th century, physician Paracelsus (1493 to 1541) noted that chickens made to breathe it not only fell asleep but also felt no pain, but it was used only as a recreational drug until it was adopted as an anesthetic for surgery in the 19th century.

James Venable, a student of the American physician Crawford W. Long, wanted to remove two small tumors but, fearing the pain of surgery, he kept putting off the operation. Dr. Long had noticed that his friends had felt no pain while experimenting with ether and suggested using the gas during the operation. Dr. Long removed the tumours without pain, on 30 March 1842, but did not announce his discovery until 1849.

In 1845, in Boston, Massachusetts, Horace Wells tried unsuccessfully to use nitrous oxide as an anesthetic but on 16 October 1846, Boston dentist William Thomas Green Morton successful demonstrated the use of diethyl ether to an audience of medical students.

Morton was invited to demonstrate his new painless surgery technique for the surgeon John Collins Warren.  Warren was skeptical but, after Morton had induced anesthesia and Warren had removed a tumor from the neck of Edward Gilbert Abbott, he was impressed, remarking, 'Gentlemen, this is no humbug.' Morton tried to conceal the nature of his anesthetic substance but news quickly spread and by late 1846, surgeons in Europe, including Liston, Dieffenbach, Pirogov, and Syme, were all using ether during surgery.

Later, problems with excessive vomiting and ether's flammability caused it to be replaced with chloroform.

Chloroform was independently discovered in 1831 by the American physician Samuel Guthrie, Frenchman Eugène Soubeiran and Justus von Liebig in Germany. It was identified chemically and named in 1834 by Jean-Baptiste Dumas.   In 1842, Dr. Robert Mortimer Glover, in Britain, noted the anaesthetic properties of chloroform on laboratory animals and, in 1847, Scottish obstetrician James Young Simpson was the first to demonstrate the use of chloroform on humans.

Its use spread quickly and when John Snow gave it to Queen Victoria during the birth of Prince Leopold, in 1853, she remarked that it was "delightful beyond measure". But there were problems. The first fatality, directly attributed to chloroform, occurred in January 1848 and surgeons began to appreciate the need for a trained anesthetist. More often, surgeons sought out nurses to provide anesthesia and, during the American Civil War, many nurses were professionally trained to support surgeons.

In Britain, from 1848, John Snow published articles, "On Narcotism by the Inhalation of Vapours," in the London Medical Gazette. Snow was also involved in producing equipment needed for the administration of inhalational anesthetics, the forerunner of today's anesthesia machines.

In 1914, anesthesiologist Dr. James Tayloe Gwathmey and the chemist Dr. Charles Baskerville published an influential medical textbook, Anesthesia, that described the history as well as the physiology and techniques of inhalation, rectal, intravenous, and spinal anesthesia.

Today, chloroform, ether and cocaine have all been replaced by safer, more effective anesthetics leaving only nitrous oxide and the opiodes, derived from the opium poppy, still widely used to control pain during surgery.